CAST was the largest trial to provide evidence about major depressive disorder treatment with a commonly used SSRI in patients with non-dialysis-dependent CKD.

Sertraline did not significantly improve depressive symptoms in patients with non-dialysis-dependent chronic kidney disease (CKD), according to the results of the CKD Antidepressant Sertraline Trial (CAST) published in JAMA.

In this 12-week randomized controlled trial, researchers randomly assigned patients with non-dialysis-dependent stage 3 through 5 CKD to receive sertraline 50 mg/d (n=102) or placebo (n=99) after a 1-week placebo run-in. Sertraline could be uptitrated to 200 mg/d based on tolerability and response. They evaluated depressive symptom severity at baseline and 12 weeks with the 16-item Quick Inventory of Depression Symptomatology-Clinician Rated (score range 0 to 27).

Mean baseline depressive symptoms were similar in both groups (14.0 vs 14.1). The median participation was 12 weeks, and the median dosage was 150 mg/d.

After 12 weeks of treatment, the change in depressive symptom severity from baseline was not significantly different in the sertraline group compared with placebo (-4.1 vs -4.2; between-group difference 0.1, 95% CI, -1.1 to 1.3; P =.8). In a similar fashion, no significant difference was reported for changes in patient-reported overall health (0 vs 0; between-group difference 0; 95% CI, -10.0 to 0; P =.61).

Nausea or vomiting and diarrhea occurred more frequently in the sertraline group than in the placebo group (P =.03 and P =.02, respectively).

The study investigators noted that this study was "the largest randomized, double-blind, placebo-controlled trial to provide evidence about [major depressive disorder] treatment with a commonly used [selective serotonin reuptake inhibitor] in patients with non-dialysis-dependent CKD, a chronically ill population that is not only at significantly increased risk for developing depression, but also its serious complications."